Low FODMAP Diet

(FODMAP= Fermentable Oligo-Di-Monosaccharides and Polyols)

This diet is specially designed to reduce symptoms of irritable bowel syndrome (IBS) such as abdominal pain, constipation, diarrhea, bloating, excessive gas and other gastrointestinal symptoms. FODMAPs are carbohydrates (sugars) found in multiple foods we eat on a daily basis. However, not all carbohydrates are considered FODMAPs. FODMAP is an acronym referring to:

Fermentable Oligosaccharides (fructose molecule chains) Disaccharides: Lactose (dairy) and excess fructose (fruits, high fructose corn syrup) Monosaccharides And Polyols: Sorbitol, Mannitol, Maltitol, Xylitol, Isomalt (artificial sweeteners or organic sweeteners)

These are complex names for an assortment of molecules found in foods that can be poorly absorbed by some people. When the molecules are poorly absorbed in the small intestine of the digestive tract, these molecules then continue into the large intestine. In the large intestine, these molecules then become a food source to the bacteria that live there normally. The bacteria then ingest these FODMAPs which leads to malabsorption and symptoms of irritable bowel syndrome (IBS).

TIPS

• No two patients with IBS are the same so it is important for individuals to tailor their diet based on their own symptoms. Completely eliminating high FODMAP foods for 6 weeks is recommended. • Avoid foods made with high FODMAPs such as high FODMAP fruits, HFCS (high- fructose corn syrup), honey, inulin, wheat, etc. However, a food may still be an overall low FODMAP food if a high FODMAP food is listed as the last ingredient.

• Buy gluten-free grains (as they are wheat-free). However, you do not need to follow a 100% gluten-free diet -- the focus is on FODMAPs, not gluten. Look for gluten-free grains made with low FODMAPs, such as potato, quinoa, rice or corn. • To identify foods that could be “triggers” to your symptoms, add high FODMAP foods back into your diet one at a time. Limit foods that trigger your symptoms. This will help pinpoint your individual level of tolerance. • Many people ask about Truvia®. Although the product is “natural”, IBS sufferers who are sensitive to FODMAPs could potentially experience symptoms when consuming this sweetener in large quantities. It is suggested that you wait to try these “natural” sweeteners only after symptom are controlled 6-8 weeks. • Eating out or going on holidays can pose a challenge but the occasional slip up can help provide proof that the diet is working.

Low FODMAP Meals and Snack Ideas

. Gluten-free waffle with walnuts, blueberries, maple syrup without HFCS. . Eggs scrambled with spinach, bell peppers and cheddar cheese. . Oatmeal topped with sliced banana, almonds and brown sugar. . Fruit smoothie blended with lactose-free vanilla yogurt and strawberries. . Rice pasta with chicken/firm tofu, tomatoes, spinach topped with pesto sauce. . Chicken salad mixed with chicken, lettuce, bell peppers, cucumbers, tomatoes, balsamic vinegar salad dressing. . Turkey wrap with gluten-free tortilla, sliced turkey, lettuce, tomato, cheddar cheese slice, mayonnaise, mustard. . Ham and Swiss cheese sandwich on gluten-free bread, with mayonnaise, mustard. . Quesadilla with gluten-free or corn tortilla, cheddar cheese and/or firm tofu. . Beef and vegetable stew (made with homemade broth, beef, allowed vegetables).

Sites for low FODMAP recipes: http://www.taste.com.au/recipes/collections/low+fodmap+diet+recipes http://www.lowfodmaprecipes.co.uk/

References: Low FODMAP Diet (2013). In Shepherd Works. Retrieved February 1, 2013, from http://shepherdworks.com.au/disease-information/low-fodmap-diet

The Low FODMAP Diet (2012, August). In Digestive Health Center at Stanford Hospital and Clinics. Retrieved February 1, 2013, from http://stanfordhospital.org/digestivehealth/nutrition/DH-Low-FODMAP-Diet-Handout.pdf

FODMAP DIET

Foods that DO NOT CONTAIN FODMAP – FRIENDLY FOODS

Fruit Milk products Breads/grains IN MODERATION Bananas, grapefruit, Lactose free milk, lactose free Gluten-free bread and cereals Beets -4 slices blueberries, grapes, honeydew ice cream, lactose-free cottage (check ingredients) 100% spelt Broccoli (½ cup), Brussels melon, cantaloupe, clementine, cheese, lactose-free yogurt bread corn, rice and quinoa sprouts (½ cup), butternut squash (¼ cup), fennel bulb (½ coconut, dragonfruit, grapefruit, and sorbets, rice milk, gelati, pasta, rice cakes, potato and cup), green peas (1/3 cup), kiwifruit, lemons, limes, milk free spread tortilla chips, rice, quinoa, oats, pomegranate (½ cup), savoy mandarin, oranges, papaya, corn breads Cheeses cabbage (1cup), snow peas pawpaw, passionfruit, (10 pods), sweet corn (½ cob), pineapple, rockmelon, Brie, cheddar, feta, mozzarella, ¼ of an avocado, celery (1 raspberries, rhubarb, starfruit, parmesan, Swiss, hard Nuts/Seeds stick), cherries (3), lychee (5), strawberries, tangelos cheeses and camembert sweet potato (½ cup) (10-15 max or 1-2 tablespoons) NOTE: Vegetables Sweeteners Almonds, Peanuts, pecans, pine nuts, walnuts, pumpkin - 1 serving of fruit per Arugula, Bamboo shoots, bok Maple syrups, table sugar seeds, sesame seeds, meal max. choy, bean sprouts, bell (sucrose), golden syrup, sunflower seeds, 2 TB chia - 1 medium orange or peppers, carrots, celery, glucose, artificial sweeteners seeds, 1 TB flax. banana. capsicums, chokos, coy sum, not ending in –ol, example- - 1 cup berries, corn, carrots, cabbage, Aspartame Firm tofu cantaloupe, pineapple eggplant, green beans, lettuce, or rhubarb. endive, kale, chives, parsnips, pumpkin, potatoes, radish, Alcohol rutabaga, spinach, swiss Most wines and beers, vodka chard, silver beet, spring onion and gin (limit 1 drink in general

(green part only), turnip, as alcohol is a gastric irritant) tomatoes, water chestnuts, zucchini.

Substitutes- can use garlic/ onion infused oil.

FODMAP DIET

Foods that CONTAIN FODMAP – Please AVOID

Excess fructose Excess lactose Fructans Polyols

Fruits Milk Fruit Fruits

Apples, pears, nashi, Cow, goat and sheep’s milk Custard apples, figs, nectarine, Apricot, cherries, lychees, mangoes, canned fruit in yogurt, ice cream, evaporated persimmon, white peaches, nashi, pears, peaches, plums, natural juice, watermelon, milk, custards watermelon prunes, blackberries boysenberry, cherries, figs Cheese Vegetables Vegetables Sweeteners Soft and fresh (e.g. ricotta, Beats, brussels sprouts, Avocados, mushrooms, Fructose, high fructose corn cottage) cabbage, fennel, chick peas, cauliflower, pumpkin, snow syrup, honey, agave lentils, red kidney beans, peas

baked beans, soybeans and Large fructose doses - Sweeteners

soy milk, okra garlic, leeks, Concentrated fruits sources, Sorbitol, mannitol, maltitol, onions, shallots, garlic powder large servings of fruits, dried isomalt, xylitol ( sugar-free, Grains and nuts fruits and fruit juice mint cough drops and in some Rye, wheat and barley- avoid medications) Vegetables in large quantities (e.g. breads,

Artichokes, asparagus, sugar pastas, crackers, biscuits) snap peas inulin (may be labeled as Alcohol chicory root or FOS)

Rum pistachios, cashews